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Cranial nerve testing and abnormal findings NPTE

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Examination of CN I integrity and abnormal findings   Identification of familiar odors (e.g. chocolate, coffee) Possible abnormal findings: Anosmia (inability to detect smells), seen with frontal lobe lesions  
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Examination of CN II integrity and abnormal findings   Test visual acuity Central: Snellen eye chart, test each eye separately by covering other eye, test at distance of 20 ft. Abnormal findings: Blindness; myopia(impaired far vision); Presbyopia (impaired near vision; Homonoymous hemianopsia  
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Examination of CN III integrity and abnormal findings   Test upward, downward, and medial gaze. Test reaction to light Abnormal findings: Aniscoria (unequal pupils;Horner's syndrome) Strabismus: eye pulled outward by CN VI, Ptosis, pupillary dilation, inability to look up down or medially  
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Examination of CN IV integrity and abnormal findings   Test: persuit eye movement - Superior oblique turns an adducted eye downward Abnormality: eye cannot look down when it is adducted.  
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Examination of CN V integrity and abnormal findings   Test pain light touch sensations on forehead, cheeks and jaw (eyes closed) Test corneal reflex Abnormalities: loss of facial sensations. Loss of corneal reflex ipsilaterally (blinking in response to corneal touch)  
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Examination of CN VI integrity and abnormal findings   Test: Lateral gaze Abnormal findings: Esotropia(eye pulled inward), eye cannot look outward  
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Examination of CN VII integrity and abnormal findings   Test motor function of facial muscles: Raise eyebrows, frown, show teeth, smile, close eyes tightly, Puff out both cheeks Abnormality:Paralysis of ipsilateral facial muscles, inability to close eye, droop in corner of mouth,(bells palsy)  
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Examination of CN VIII integrity and abnormal findings   Test balance: vestibulospinal function Abnormal finding: vertigo, dysequilibrium Test: eye-head coordination: vestibular ocular reflex (VOR) Abnormal finding: gaze instability with head rotations; nystagmus Test: hearing, --Deafness, tinnitus  
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Examination of CN IX integrity and abnormal findings   Test: Gag reflex: stimulate back of throat lightly; ability to swallow Abnormal findings: absent gag reflex  
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Examination of CN X integrity and abnormal findings   Examine for difficulty in swallowing "Say Ahh" observe motion of soft palate (should elevate) and uvula (should remain midline) Abnormal findings: Dysphonia: hoarseness denotes vocal cord paralysis ;Dysphagia;palate fails to elevate  
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Examination of CN XI integrity and abnormal findings   Examine bulk;strength, resisted shoulder shrug, turn head to each side against resistance Abnormal findings: inability to turn head to opposite side; inability to shrug ipsilateral shoulder;shoulder droops; atrophy, fasiculations, weakness.  
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Examination of CN XII integrity and abnormal findings   Test: tongue protrusion, listen to patients articulation Abnormality: if injured tongue deviates toward injured side. Dysarthria (lesions of CN X or XII). Atrophy or fasiculations of tongue.  
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